Three key strategies — knowledge capture, regulatory and policy capture, and shaping the public narrative — make up the “corporate playbook” that companies utilize to undermine public health in order to “prioritize profits over health,” according to research published by The New England Journal of Medicine.
The research, titled “Corporate Vectors of Chronic Disease” was done by a consortium of researchers from the Center to End Corporate Harm at the University of California, San Francisco (UCSF). The consortium, which includes the University of Nevada Reno, looked at six health-harming industries: tobacco, pharmaceutical, fossil fuel, food, chemical (manufactured for commerce and pesticides), and opioids.
These industries that manufacture and market health-harming products are a “primary vector” for the rapid increase in mortality rates related to noncommunicable diseases, the document said. “They make products (agents) and expose people (hosts) to these products or influence their consumption, which results in health harms.”
Globally, five of the commercial products that the industries produce contribute to 31% of all deaths each year: fossil fuels, 8.1 million; tobacco; 7.2 million; ultraprocessed foods, 2.3 million; manufactured chemicals, 1.8 million; and alcohol, 1.8 million.
The researchers drew on the Industry Documents Library, or IDL, which is a public database archived at UCSF containing more than 24 million industry documents that were crucial to bringing changes to tobacco policy.
“This research article highlights the IDL database and also showcases what these corporations are all about,” said Eric Crosbie, an associate professor at UNR’s School of Public Health. Crosbie’s research looks into commercial determinants of health.
The documents illustrate the strategies these companies use to circumvent regulation and public scrutiny, Crosbie said.
Attack the science and data
Knowledge capture, or “influence over science exploring corporate products and their health effects,” is a key strategy companies turn to in the course of profiting at the expense of public health. Companies attack and discredit independent scientists who challenge industry assertions, Crosbie said. Scientific data on health hazards caused by products are suppressed and then research is sponsored by the company to refute or minimize those harms.
An example of knowledge capture, according to the researchers, was U.S. chemical manufacturers DuPont and 3M downplaying the toxicity of perfluoroalkyl and polyfluoroalkyl substances (PFAS), which is used in teflon, and suppressed “for more than 20 years internal studies showing adverse effects of PFAS.” Other chemicals included perfluorooctanoic acid, or PFOA, and perfluorooctanesulfonic acid, or PFOS.
The chief of toxicology for a DuPont brand knew that PFAS were toxic and recommended that the substances “be handled with extreme care,” according to a 1961 internal research document. Both DuPont and 3M knew that 2 of 8 DuPont employees that were pregnant “gave birth to children with eye or facial defects” in 1980. “Suppression of these data allowed DuPont and 3M to continue to use PFOA and PFOS in the United States, and such use led to widespread human exposure,” the research article said.
Another case, Crosbie noted, was the tobacco industry and the harm of secondhand smoke. The big tobacco companies knew about secondhand smoke and its medical harm as early as the 1950s, Crosbie said, and would go to academic conferences and hire scientists to deflect the blame on to other potential causes, like indoor air pollution.
“They were very good at discrediting and misdirecting science. They would say ‘This isn’t a secondhand smoke problem. No, this is a problem of the ventilation systems that are not adequate in these facilities,’” Crosbie said.
Smoking remains an outsized public health challenge in Nevada, according to Crosbie, as casinos are one of the remaining public places where smoking is permitted indoors. In 2024, he and four other researchers monitored air quality in smoking and nonsmoking areas at casino and gaming locations in Reno and Sparks. They found that indoor areas consistently had higher secondhand smoke levels than outdoor readings and that all minors present in casino locations were likely exposed. “Establishing comprehensive smoke-free casinos is the only way to protect against secondhand smoke harms,” the 2024 research article said.
“Think about that blackjack dealer or that bartender who never smoked a cigarette a day in their life,” Crosbie said, but who are subjected to enough secondhand smoke to contract and die from emphysema or cancer.
Astroturfing and revolving doors
A second key tactic that health-harming industries use is regulatory and policy capture: “manipulating policy and regulation to create favorable environments for their products.”
This is often done by the direct lobbying of politicians and financing their campaigns. But capturing policymakers is also accomplished with the assistance of industry-funded “front groups” that portray themselves as independent organizations, even to the extent of manufacturing fake activist organizations to combat policy that would hinder profit, which Crosbie calls their astroturfing strategy.
One example of astroturfing that Crosbie noted was when San Francisco was considering a soda tax. Soft drink companies funded astroturfed organizations masquerading as grassroots groups to fight the legislation. The organizations have a long history of popping up anytime a soda tax is proposed throughout the United States, as reported by Forbes.
Sugar-sweetened beverages like soda are significant contributors to obesity, which the World Health Organization terms a “global public health crisis.”
Former US House Speaker John Boehner is a clear example, according to Crosbie, of the “revolving door” that exists between corporations and government. Boehner resigned from office in 2015 and joined the board of tobacco company Reynolds American in 2016, taking all connections in Washington and legislative knowledge with him to the corporate world, Crosbie said.
This, noted Crosbie, is called corporate capture. “They’ve captured these institutions and agencies that are supposed to regulate them and now a conflict of interest exists,” he said.
Recruiting school nurses to encourage childhood opioid use
Shaping the public narrative is the third key corporate strategy identified in the research published in the New England Journal of Medicine. Consumers are captured by sophisticated advertising and marketing campaigns, backed by armies of public relations firms, front groups and think tanks.
The report notes that opioid manufacturers “deployed particularly insidious advertising strategies” for marketing their product, such as “recruiting youth coaches and school nurses to encourage opioid use by children.” Researchers discovered examples by examining court documents in a landmark case filed by the state of Oklahoma against Johnson & Johnson, Purdue Pharma and 11 other opioid manufacturers. These court documents were archived into the IDL database at UCSF and published in a separate research article in 2022.
“What is great about these documents is that it shows, word for word, what they’re doing. We are not speculating, we’re just reading what they don’t want the public to see,” Crosbie said.
More than 600,000 deaths each year globally are attributable to drug use or overdose, mostly from opioids. Nevada moved into the top 10 for rate of overdose deaths in 2023, and is one of only three states nationally where deaths have increased since 2023.
Health-harming corporations translate “pervasive strategies from one health-harming product to another” as well. Between 1960 and 2010, the article notes, the largest tobacco companies in the US also owned some of the largest processed food companies in the world, like Nabisco, Del Monte and Kraft-General Foods.
The tobacco company R.J. Reynolds acquired Hawaiian Punch in 1963, which was originally marketed solely as a cocktail mixer. Only a few years later, R.J. Reynolds “reformulated and rebranded Hawaiian Punch as a children’s beverage” with different flavors and marketed with a children’s cartoon character named “Punchy.”
“The important part is that we need to shine a light on how crooked and corrupt these companies are, and how aggressively they target people,” Crosbie said. “If people really saw the truth, they wouldn’t think the same about these companies.”
What public health researchers like Crosbie aim to do with these industry documents is to develop counter-strategies.
“If I go to testify, I will say some of the results of my study, but I will outline the 10 arguments that the opposing side is going to say. So then it’s up to the policymakers to see through their argument,” he added.
The researchers note that it is an uphill battle due to corporate lobbying and campaign-finance laws that “place few restrictions on corporate donations to political parties and candidates.”
“If we do more bottom-up approaches, what you start to see is social norm changes and diffusion of best practices,” Crosbie said, noting aggressive programs and policies implemented in the 1980s and 1990s which dramatically reduced the coolness, and hence the prevalence, of smoking.
Crosbie used the game Monopoly as an example. If corporations that manufacture health-harming products keep changing the rules of the game to their favor, they’re always going to win. “We need to change the rules of the game to favor public health and the environment,” he said.
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